Role of delayed enhancement cardiac magnetic resonance in the evaluation of hypertrophic cardiomyopathy

Background: Hypertrophic cardiomyopathy is a genetic heart illness distinguished by unexplained left ventricular hypertrophy, with CMR and delayed gadolinium enhancement playing a key role in detecting myocardial fibrosis and refining diagnosis and risk stratification. Aim: To identify and assess the role and sensitivity of delayed myocardial enhancement with cardiac magnetic resonance imaging in cases of hypertrophic cardiomyopathy. It provides the panorama and useful information prior to the management. Patients and methods: This research was performed on 100 cases referred to the radiology departments at Al-Sayed Galal University Hospital and Al-Hussien University Hospital, in the period from April 2023 to September 2025, and this research was performed following approval of the ethics committee and scientific research of the faculty of medicine, Al-Azhar University. Results: The research population had a mean age of 38.73 ± 16.51 years, with 72.0% males and a mean BSA of 1.98 ± 0.26 m². LGE was absent in 45.0% of patients, with midmyocardial enhancement most common (37.0%). Absence of LGE was frequent in dilated cardiomyopathy, while midmyocardial enhancement predominated in amyloidosis, myopericarditis, and HCM. LGE-positive patients had higher rates of smoking, diabetes, and hypertension, and significant differences in final diagnoses were observed between LGE-positive and LGE-negative groups. Conclusion: DE-CMR is a valuable non-invasive instrument for finding myocardial fibrosis and improving diagnostic accuracy in HCM and other cardiomyopathies. LGE presence and patterns correlate with diagnoses, risk factors, and cardiac function, highlighting the prognostic role of CMR in patient management.